UCI Rethinks Diagonistic Procedures

UCI students and professors are working toward creating a new system for identifying malaria in patients using saliva instead of blood. The project is aimed at making it easier for healthcare workers to diagnose malaria in the third world so that they can more effectively fight the disease.

Students under Professor William Tang, the Assistant Dean of the School of Engineering went to the Thailand Myanmar border last year to analyze the methods that local medical personnel employ in identifying and treating malaria in patients and how to improve the system. One major recommended improvement was to find a pain-free way to get samples from children, who make up the majority of new malaria cases.

“Most of the infected patients are children, 85 percent of them are children, and most of the fatality the death is happening to children,” Tang said.

The project originated in Tang’s laboratory but expanded as a senior design project for biomedical engineering students in 2012, but it will continue now that the students have graduated. Tang expects to find new students and expand the program so that it will be completed.

Malaria is a serious global health issue and is responsible for thousands of deaths a day worldwide. According to the World Health Organization in 2010, an estimated 660,000 people died from malaria, and over 80 percent were children.

Malaria is prevalent in the tropics and the majority of deaths come from Africa, though Southeast Asia, and Myanmar in particular are major zones for malaria. For this reason the border region of Thailand and Myanmar was the center of focus for the project.

The area has a high rate of malaria due to the tropical climate and the geography. The border between Thailand and Myanmar is the Moei River which acts as a breeding mosquitoes, the main transmitter of malaria. This coupled with poverty, lack of medical care, and a high density of immigrant populations makes the border region between Thailand and Myanmar breeding ground for malaria.

This fact isn’t helped by what Tang sees as an inefficient method for diagnosing and treating malaria.

The process begins when a medical worker checks a patient if they have a fever, as fevers are a major symptom of malaria. Then the worker will prick one of the patient’s fingers to get a blood sample to be taken to a clinic where a doctor examines it under a microscope. It is then up to the doctor to determine if the blood indicates the person has malaria.

Tang does not like this aspect, as he thinks it is too subjective and diagnoses can differ depending on which doctor is analyzing the blood sample. If the sample is diagnosed with malaria then the field worker is given medicine so that they can give it to the patient, however the workers often don’t get the drugs until the next day due to delays.

Tang believes the method by which health workers in Thailand check for malaria in patients is slow and ineffective and should be replaced.
“We know that we would like to replace the technician and replace using the microscope with a diagnostic platform that would objectively tell us whether the patient is having malaria,” he said.

His issue with the process is one of the reasons why the project was started. Originally the idea was to have the device use blood samples but after seeing that most of the infected patients were children who were afraid of giving blood samples he decided to switch the platform to use saliva instead.

“We have seen that the kids, they are really afraid of the needles and seeing blood and all that. They cry before the finger prick, they cry during, and they cry after. So most of the patients we come across are children so we figured that wouldn’t it be nice to not have to do that to children and be able to diagnose malaria without a finger prick,” Tang said.

Instead of using a blood sample, Tang’s proposed system would use saliva, which does not hurt the patient. According to Tang, the system would work much like a blood glucose meter with disposable test strips and would be about the size of a cell phone.
Such a system would give results in 15 to 30 minutes as opposed to several hours with a blood sample. Such a development would allow health workers to make a diagnosis on the spot and allow workers to give medicine on the spot as opposed to having to wait for the sample to be delivered to a clinic before a diagnosis can be determined.

This would cut wait times and eliminate a constant problem that field workers in Thailand face. Due to the long wait time for blood samples, many health workers go to individual communities and promise to bring back drugs if a person has malaria, however sometimes they are unable to find their patients again as most of the residents are refugees who move around constantly. This results in a large number of infected people not getting the medicine that they need.

“With the results they [get medicine], and then with the results they take the drug, the anti-malaria medicine [and] go back to the house or village or refugee camps and try to find the same patient to give the drug to. What we are told is that half the time they cannot find the same patient again because that area of the Thailand/Myanmar border is mostly populated by refugees,” Tang said.

Because of these problems, a quicker and more efficient system is needed and Tang believes his idea can help make that happen.
Tang has received funding from the Defense Advanced Research Projects Agency (DARPA), UC Irvine, the Undergrad Research Opportunity Program and Everett’s Life Science for the project. While Wang has a prototype planned, it is not scheduled to be ready for two years.

Once it is ready for field use the plan is for the group to go to Thailand to test the system in the field and make adjustments as needed.